Report of Director of Public Health
Councillor Woodings, Portfolio Holder for Adult Social Care and Health, introduced the report.
Lisa Lopez, Public Health Commissioning Lead, presented the report and stated the following:
(i) the report sought approval to commission a Mental Health Reablement service to provide support to some of Nottingham’s most vulnerable citizens with mental health needs;
(ii) the service would provide support to citizens around physical and mental health, financial wellbeing, housing/tenancy issues and access to services to help them to develop coping strategies and remain living as independently as possible in the community;
(iii) it would support citizens with complex support needs, including but not limited to those associated with drug use, alcohol use, offending and diagnosed or suspected alcohol-related brain injury, and prevent costs in other services such as health, including emergency health services, facilitate timely discharge from psychiatric wards and reduce the number of Delayed Transfers of Care (DTOC);
(iv) the Office of Health Improvement and Disparities has set out three key overlapping priority areas of public mental health across the life course:
- mental health promotion;
- prevention of mental health problems and suicide prevention;
- improving lives, supporting recovery and inclusion of people living with mental health problems.
The Mental Health Reablement Service has the potential to support the delivery of all three of these priorities, with a particular emphasis on improving lives, supporting recovery and inclusion within the community of people with mental health problems;
(v) The Care Act 2014 requires local authorities to ensure that their citizens have access to services that prevent escalation of, and/or delay, the impact of their needs, and have access to a range of high quality, appropriate services. The service will support Nottingham City Council’s statutory responsibilities in respect of this;
(vi) Nottingham City is an outlier in not having commissioned a Mental Health Reablement Service. Such services are widely recognised for their preventative value and are common in other core and neighbouring cities. Nottingham City Council was to commission a Mental Health Reablement service in 2020, but due to budget pressures the contract was not awarded.
(a) procurement of a Mental Health Reablement Service (as detailed in appendix 1) via a tender process, and award contracts for the services as appropriate, commencing 1 October 2023 for an initial term of 2 years, with an option to extend for a further 2 years (2+2);
(b) total expenditure of £1,600,000 over the entirety of the contract for provision of Mental Health Reablement Services, noting that this will comprise of £800,000 from Public Health reserves for the first two years, followed by £100,000 per year from the Public Health Grant and £300,000 per year from Adult Social Care should the contract be extended for the following 2 years;
(2) note that the:
(a) Director of Public Health has authority to approve the outcome of the procurement process and award the contract(s) to the provider(s) deemed most suitable;
(b) Director of Legal and Governance, or their delegate, has authority to sign initial contracts and, should the option be used, agree an extension, subject to budget availability.
Reasons for recommendations
(i) The service will provide support to some of Nottingham’s most vulnerable citizens with mental health needs, to enable them to remain independent in the community and to facilitate discharge from psychiatric wards. The proposed service is to provide timely, flexible, intensive, fixed-term support to increase citizens’ independence and help them to manage or overcome social, practical, financial, emotional and health-related difficulties. The proposed service will support service users to develop coping strategies and the ability to manage periods of problematic mental ill health, directly addressing issues in citizen’s lives that impact negatively on their mental health and wellbeing.
(ii) Each citizen receiving support will have a personalised, strengths-based support plan which aims to promote and maximise independence by utilising support available through this service and other community-based resources, thus supporting recovery and enabling them to live as independently as possible. There are currently approximately 393 citizens within the Mental Health Pathway who would potentially benefit from a period of Reablement. This service is expected to have the capacity to meet the needs of this group of citizens.
(iii) The service will prevent costs to other services such as health, including emergency health services, facilitate timely hospital discharge and reduce the number of Delayed Transfers of Care (DTOC). The proposed service will include in-reach into psychiatric units, and will work collaboratively with hospital colleagues in order to identify patients who would benefit from the reablement service; particularly where this would help to facilitate their discharge. This will support citizens to return home safely, provide support for a fixed period once they return home, and help to prevent avoidable re-admissions.
(iv) The service will support Nottingham City Council’s statutory responsibilities. The Care Act 2014 requires local authorities to ensure that citizens who live in their areas receive services that prevent their care needs from becoming more serious, or delay the impact of their needs; have access to the information and advice they need to make good decisions about care and support; have a range of provision of high quality, appropriate services to choose from; and have an individual care plan to meet their needs.
(v) The Care Act legislates to improve citizen’s independence and wellbeing. It makes clear that local authorities must provide or arrange services that help prevent citizens developing needs for care and support or delay citizens deteriorating so much that they would need more acute and ongoing care and support or be admitted to hospital. The service will address citizens’ key support needs and so contribute to better mental and physical health. The service will support citizens towards greater independence, help to prevent escalation of need, and minimise risks / vulnerabilities.
(vi) The recent Strategic Commissioning Review suggests that the proposed service will provide value for money when compared against other provision within the mental health pathway such as residential care or accommodation-based Care Support and Enablement. The service is to be jointly funded by Nottingham City Council Public Health and Adult Social Care budgets (see appendix 1) with the Public Health reserves being used to fund the service for the first 2 years, followed by 25% Public Health funding and 75% Adult Social Care funding in subsequent years. The service is being commissioned as ‘invest to save’ with the initial Public Health funding providing the investment to implement the service, for it to generate savings in Adult Social Care and Health in subsequent years.
Other options considered
(i) Do nothing - do not commission the services. Lack of preventative services for citizens who are not Care Act eligible is contributing to additional spend and pressure in Adult Social Care and elsewhere in the system, such as housing and health. This is particularly true for specialist services like the Mental Health Reablement service, where a significant proportion of potential service users are eligible for support under the Care Act.
(ii) A key component of the Mental Health Reablement service is the hospital in-reach. This diverts citizens away from Adult Social Care, particularly where there is a housing need. The lack of this part of the service specifically is likely to mean that the level of delayed transfers of care (DTOC) are occurring, reducing the capacity on the acute wards. This is likely to mean significantly poorer outcomes for the citizen, as well as increased costs to the local authority and Health. Therefore, this option is not recommended.